Mergers and acquisitions of nonprofit hospitals are on the rise. Proceeds from many of these transactions will endow new health legacy foundations (HLFs). These philanthropic entities have substantial potential for charitable investment in US communities. Research indicates that the greatest improvements in population health can be achieved by addressing underlying social factors. Determining whether communities served by HLFs are characterized by poor social determinants of health would provide new information for developing effective grant-making strategies. Our study compared socioeconomic, demographic, and health care access indicators in HLF versus non-HLF counties. Compared with non-HLF counties, HLF counties had significantly higher proportions of racial minorities and multiple socioeconomic factors that rendered them more vulnerable to health disparities and poor health. However, HLF counties had better access to health care. These findings have direct implications for HLF leadership, planning, and grant making.